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NPI
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N/D
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10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
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Entity Type
|
N/D
|
Code describing the type of health care provider that is being assigned an NPI. Codes are:
- 1 = (Person): individual human being who furnishes health care;
- 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
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Replacement NPI
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N/D
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The most recent NPI issued by the NPS to this provider. Issuance of a Replacement NPI by the NPS would be an unusual circumstance in which the provider requested a new, different NPI for a valid reason. Issuance of a Replacement NPI is different from NPI deactivation and NPI reactivation.
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Employer Identification Number (EIN)
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N/D
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The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. An Employer Identification Number (EIN) is assigned by the Internal Revenue Service (IRS) to identify a business entity. It may or may not be that business entity's Taxpayer Identification Number (TIN). An SSN should not be entered in the EIN field.
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Is Sole Proprietor
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N/D
|
Indicate whether provider is a sole proprietor.
- A sole proprietor is the sole (the only) owner of a business that is not incorporated; that unincorporated business is a sole proprietorship.
- In a sole proprietorship, the sole proprietor owns all of the assets of the business and is solely liable for all of the debts of the business.
- There is no difference between a sole proprietorship and a sole proprietor; they are legally a single entity: an individual.
- In terms of NPI assignment, a sole proprietor is an Entity type 1 (Individual) and is eligible for only one NPI (the sole proprietorship business is not eligible for its own NPI).
- As an individual, a sole proprietorship cannot be a subpart and cannot have subparts. (See NPI Final Rule for information about subparts.)
- A sole proprietorship may or may not have employees.
- Often, the IRS assigns an EIN to a sole proprietorship in order to protect the sole proprietor's SSN from disclosure in claims or on W-2s. NPPES does not capture a sole proprietorship's EIN.
- Many types of health care providers could be sole proprietorships (for example, group practices, pharmacies, home health agencies).
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Is Organization Subpart
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N/D
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The "Is the organization a subpart?" question must be answered. If the organization is a subpart = , the Parent Organization Legal Business Name (LBN) and Parent Organization Taxpayer Identification Number (TIN) fields must be completed. The Parent Organization LBN and TIN fields can only be completed if the answer to the subpart question is Yes.
Many organization health care providers who apply for NPIs are not legal entities themselves but are parts of other organization health care providers that are legal entities (the "parents").
Here are three examples of organization health care providers that may be considered subparts and may apply for NPIs if so directed by their "parents":
(1) The psychiatric unit in a hospital is not a legal entity but is part of the hospital (the "parent"), which is a legal entity. The legal entity must obtain an NPI. The psychiatric unit is an example of a subpart that could have its own NPI if the hospital determines that it should.
(2) A group practice that is not a sole proprietorship has a main location and could have other offices in different locations, but each office is not a separate legal entity; instead, each office is part of the corporation (the "parent") which is a legal entity. The offices are examples of subparts that could have their own NPIs if the main location determines that they should.
(3) A pharmacy fills prescriptions for patients whose physicians have prescribed medications for them and may also rent or sell durable medical equipment to patients whose physicians have ordered such equipment for them. Neither the pharmacy line of business nor the DME line of business represent legal entities; instead, both lines of business are part of an organization (the "parent") that is a legal entity. Each line of business represents a different Healthcare Provider Taxonomy or area of specialization that often submits its own electronic claims to health plans.
The "parent"-we don't know who the parent is in this example-must ensure that each subpart that submits its own claims to health plans has its own NPI.
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Parent Organization LBN
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N/D
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If the organization is a subpart, the Parent Organization Legal Business Name (LBN) field must be completed. The Parent Organization LBN field can only be completed if the answer to the subpart question is Yes.
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Parent Organization TIN
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N/D
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If the organization is a subpart = , the Parent Organization Taxpayer Identification Number (TIN) field must be completed. The Parent Organization TIN fields can only be completed if the answer to the subpart question is Yes.
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Provider Organization Name (Legal Business Name)
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N/D
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Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
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Provider Last Name (Legal Name)
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N/D
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|
The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
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Provider First Name
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N/D
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The first name of the provider, if the provider is an individual.
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Provider Middle Name
|
N/D
|
|
The middle name of the provider, if the provider is an individual.
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Provider Name Prefix Text
|
N/D
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|
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
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Provider Name Suffix Text
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N/D
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The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
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Provider Credential Text
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N/D
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The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
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Provider Other Organization Name
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N/D
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Other name by which the organization provider is or has been known.
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Provider Other Organization Name Type Code
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N/D
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Code identifying the type of other name. Codes are: 3 = doing business as (d/b/a) name; 4 = former legal business name; 5 = other.
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Provider Other Last Name
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N/D
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Other last name by which the provider being identified is or has been known (if an individual)
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Provider Other First Name
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N/D
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|
Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the ''Provider first name'' if the provider is or has been known by a different last name only.
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Provider Other Middle Name
|
N/D
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|
Other middle name by which the provider being identified is or has been known (if an individual). This may be the same as the ''Provider middle name'' if the provider is or has been known by a different last name only.
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Provider Other Name Prefix Text
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N/D
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Provider Other Name Prefix Text
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Provider Other Name Suffix Text
|
N/D
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Provider Other Name Suffix Text
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Provider Other Credential Text
|
N/D
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Provider Other Credential Text
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Provider Other Last Name Type Code
|
N/D
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|
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 5 = other.
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Provider First Line Business Mailing Address
|
N/D
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|
The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''.
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Provider Second Line Business Mailing Address
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N/D
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|
The second line mailing address of the provider being identified. This data element may contain the same information as ''Provider second line location address''.
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Provider Business Mailing Address City Name
|
N/D
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|
The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''.
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Provider Business Mailing Address State Name
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N/D
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The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''.
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Provider Business Mailing Address Postal Code
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N/D
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|
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''.
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Provider Business Mailing Address Country Code
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N/D
|
|
The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''.
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Provider Business Mailing Address Telephone Number
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N/D
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|
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''.
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Provider Business Mailing Address Fax Number
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N/D
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|
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''.
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Provider First Line Business Practice Location Address
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N/D
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|
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
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Provider Second Line Business Practice Location Address
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N/D
|
|
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
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Provider Business Practice Location Address City Name
|
N/D
|
|
The city name in the location address of the provider being identified.
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Provider Business Practice Location Address State Name
|
N/D
|
|
The State or Province name in the location address of the provider being identified.
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|
Provider Business Practice Location Address Postal Code
|
N/D
|
|
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
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|
Provider Business Practice Location Address Country Code
|
N/D
|
|
The country code in the location address of the provider being identified.
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|
Provider Business Practice Location Address Telephone Number
|
N/D
|
|
The telephone number associated with the location address of the provider being identified.
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|
Provider Business Practice Location Address Fax Number
|
N/D
|
|
The fax number associated with the location address of the provider being identified.
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|
Provider Enumeration Date
|
N/D
|
|
The date the provider was assigned a unique identifier (assigned an NPI).
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|
Last Update Date
|
N/D
|
|
The date that a record was last updated or changed.
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|
NPI Deactivation Reason Code
|
N/D
|
|
The reason that the provider's NPI was deactivated in the NPS. Codes are: 1 = death of entity type ''1'' provider; 2 = entity type ''2'' provider disbandment; 3 = fraud. 4 = other (for example, retirement).
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|
NPI Deactivation Reason
|
N/D
|
|
The reason that the provider's NPI was deactivated in the NPS.
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|
NPI Deactivation Date
|
N/D
|
|
The date that the provider's NPI was deactivated in the NPS.
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|
NPI Reactivation Date
|
N/D
|
|
The date that the provider's NPI was reactivated in the NPS.
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|
Provider Gender Code
|
N/D
|
|
The code designating the provider's gender if the provider is a person.
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|
Provider Gender
|
N/D
|
|
The provider's gender if the provider is a person.
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|
Authorized Official Last Name
|
N/D
|
|
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
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|
Authorized Official First Name
|
N/D
|
|
The first name of the authorized official
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|
Authorized Official Middle Name
|
N/D
|
|
The middle name of the authorized official
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|
Authorized Official Title or Position
|
N/D
|
|
The title or position of the authorized official
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|
Authorized Official Name Prefix Text
|
N/D
|
|
Authorized Official Name Prefix Text
|
|
Authorized Official Name Suffix Text
|
N/D
|
|
Authorized Official Name Suffix Text
|
|
Authorized Official Credential Text
|
N/D
|
|
Authorized Official Credential Text
|
|
Authorized Official Telephone Number
|
N/D
|
|
The 10-position telephone number of the authorized official.
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|
Healthcare Provider Taxonomy Code #1
|
N/D
|
|
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
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|
Healthcare Provider Taxonomy 1
|
N/D
|
|
Healthcare Provider Taxonomy #1
|
|
Provider License Number 1
|
N/D
|
|
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
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|
Provider License Number State Code 1
|
N/D
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|
Provider License Number State Code #1
|
|
Healthcare Provider Primary Taxonomy Switch 1
|
N/D
|
Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
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|
Healthcare Provider Taxonomy Code 2
|
N/D
|
|
Healthcare Provider Taxonomy Code #2
|
|
Healthcare Provider Taxonomy 2
|
N/D
|
|
Healthcare Provider Taxonomy #2
|
|
Provider License Number 2
|
N/D
|
|
Provider License Number #2
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|
Provider License Number State Code 2
|
N/D
|
|
Provider License Number State Code #2
|
|
Healthcare Provider Primary Taxonomy Switch 2
|
N/D
|
Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
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|
Healthcare Provider Taxonomy Code 3
|
N/D
|
|
Healthcare Provider Taxonomy Code #3
|
|
Healthcare Provider Taxonomy 3
|
N/D
|
|
Healthcare Provider Taxonomy #3
|
|
Provider License Number 3
|
N/D
|
|
Provider License Number #3
|
|
Provider License Number State Code 3
|
N/D
|
|
Provider License Number State Code #3
|
|
Healthcare Provider Primary Taxonomy Switch 3
|
N/D
|
Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
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|
Healthcare Provider Taxonomy Code 4
|
N/D
|
|
Healthcare Provider Taxonomy Code #4
|
|
Healthcare Provider Taxonomy 4
|
N/D
|
|
Healthcare Provider Taxonomy #4
|
|
Provider License Number 4
|
N/D
|
|
Provider License Number #4
|
|
Provider License Number State Code 4
|
N/D
|
|
Provider License Number State Code #4
|
|
Healthcare Provider Primary Taxonomy Switch 4
|
N/D
|
Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
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|
Healthcare Provider Taxonomy Code 5
|
N/D
|
|
Healthcare Provider Taxonomy Code #5
|
|
Healthcare Provider Taxonomy 5
|
N/D
|
|
Healthcare Provider Taxonomy #5
|
|
Provider License Number 5
|
N/D
|
|
Provider License Number #5
|
|
Provider License Number State Code 5
|
N/D
|
|
Provider License Number State Code #5
|
|
Healthcare Provider Primary Taxonomy Switch 5
|
N/D
|
Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
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|
Healthcare Provider Taxonomy Code 6
|
N/D
|
|
Healthcare Provider Taxonomy Code #6
|
|
Healthcare Provider Taxonomy 6
|
N/D
|
|
Healthcare Provider Taxonomy #6
|
|
Provider License Number 6
|
N/D
|
|
Provider License Number #6
|
|
Provider License Number State Code 6
|
N/D
|
|
Provider License Number State Code #6
|
|
Healthcare Provider Primary Taxonomy Switch 6
|
N/D
|
Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
|
|
Healthcare Provider Taxonomy Code 7
|
N/D
|
|
Healthcare Provider Taxonomy Code #7
|
|
Healthcare Provider Taxonomy 7
|
N/D
|
|
Healthcare Provider Taxonomy #7
|
|
Provider License Number 7
|
N/D
|
|
Provider License Number #7
|
|
Provider License Number State Code 7
|
N/D
|
|
Provider License Number State Code #7
|
|
Healthcare Provider Primary Taxonomy Switch 7
|
N/D
|
Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
|
|
Healthcare Provider Taxonomy Code 8
|
N/D
|
|
Healthcare Provider Taxonomy Code #8
|
|
Healthcare Provider Taxonomy 8
|
N/D
|
|
Healthcare Provider Taxonomy #8
|
|
Provider License Number 8
|
N/D
|
|
Provider License Number #8
|
|
Provider License Number State Code 8
|
N/D
|
|
Provider License Number State Code #8
|
|
Healthcare Provider Primary Taxonomy Switch 8
|
N/D
|
Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
|
|
Healthcare Provider Taxonomy Code 9
|
N/D
|
|
Healthcare Provider Taxonomy Code #9
|
|
Healthcare Provider Taxonomy 9
|
N/D
|
|
Healthcare Provider Taxonomy #9
|
|
Provider License Number 9
|
N/D
|
|
Provider License Number #9
|
|
Provider License Number State Code 9
|
N/D
|
|
Provider License Number State Code #9
|
|
Healthcare Provider Primary Taxonomy Switch 9
|
N/D
|
Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
|
|
Healthcare Provider Taxonomy Code 10
|
N/D
|
|
Healthcare Provider Taxonomy Code #10
|
|
Healthcare Provider Taxonomy 10
|
N/D
|
|
Healthcare Provider Taxonomy #10
|
|
Provider License Number 10
|
N/D
|
|
Provider License Number #10
|
|
Provider License Number State Code 10
|
N/D
|
|
Provider License Number State Code #10
|
|
Healthcare Provider Primary Taxonomy Switch 10
|
N/D
|
Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
|
|
Healthcare Provider Taxonomy Code 11
|
N/D
|
|
Healthcare Provider Taxonomy Code #11
|
|
Healthcare Provider Taxonomy 11
|
N/D
|
|
Healthcare Provider Taxonomy #11
|
|
Provider License Number 11
|
N/D
|
|
Provider License Number #11
|
|
Provider License Number State Code 11
|
N/D
|
|
Provider License Number State Code #11
|
|
Healthcare Provider Primary Taxonomy Switch 11
|
N/D
|
Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
|
|
Healthcare Provider Taxonomy Code 12
|
N/D
|
|
Healthcare Provider Taxonomy Code #12
|
|
Healthcare Provider Taxonomy 12
|
N/D
|
|
Healthcare Provider Taxonomy #12
|
|
Provider License Number 12
|
N/D
|
|
Provider License Number #12
|
|
Provider License Number State Code 12
|
N/D
|
|
Provider License Number State Code #12
|
|
Healthcare Provider Primary Taxonomy Switch 12
|
N/D
|
Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
|
|
Healthcare Provider Taxonomy Code 13
|
N/D
|
|
Healthcare Provider Taxonomy Code #13
|
|
Healthcare Provider Taxonomy 13
|
N/D
|
|
Healthcare Provider Taxonomy #13
|
|
Provider License Number 13
|
N/D
|
|
Provider License Number #13
|
|
Provider License Number State Code 13
|
N/D
|
|
Provider License Number State Code #13
|
|
Healthcare Provider Primary Taxonomy Switch 13
|
N/D
|
Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
|
|
Healthcare Provider Taxonomy Code 14
|
N/D
|
|
Healthcare Provider Taxonomy Code #14
|
|
Healthcare Provider Taxonomy 14
|
N/D
|
|
Healthcare Provider Taxonomy #14
|
|
Provider License Number 14
|
N/D
|
|
Provider License Number #14
|
|
Provider License Number State Code 14
|
N/D
|
|
Provider License Number State Code #14
|
|
Healthcare Provider Primary Taxonomy Switch 14
|
N/D
|
Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
|
|
Healthcare Provider Taxonomy Code 15
|
N/D
|
|
Healthcare Provider Taxonomy Code #15
|
|
Healthcare Provider Taxonomy 15
|
N/D
|
|
Healthcare Provider Taxonomy #15
|
|
Provider License Number 15
|
N/D
|
|
Provider License Number #15
|
|
Provider License Number State Code 15
|
N/D
|
|
Provider License Number State Code #15
|
|
Healthcare Provider Primary Taxonomy Switch 15
|
N/D
|
Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
|
|
Other Provider Identifier 1
|
N/D
|
|
Other Provider Identifier #1
|
|
Other Provider Identifier Type 1
|
N/D
|
|
Other Provider Identifier Type #1
|
|
Other Provider Identifier State 1
|
N/D
|
|
Other Provider Identifier State #1
|
|
Other Provider Identifier Issuer 1
|
N/D
|
|
Other Provider Identifier Issuer #1
|
|
Other Provider Identifier 2
|
N/D
|
|
Other Provider Identifier #2
|
|
Other Provider Identifier Type 2
|
N/D
|
|
Other Provider Identifier Type #2
|
|
Other Provider Identifier State 2
|
N/D
|
|
Other Provider Identifier State #2
|
|
Other Provider Identifier Issuer 2
|
N/D
|
|
Other Provider Identifier Issuer #2
|
|
Other Provider Identifier 3
|
N/D
|
|
Other Provider Identifier #3
|
|
Other Provider Identifier Type 3
|
N/D
|
|
Other Provider Identifier Type #3
|
|
Other Provider Identifier State 3
|
N/D
|
|
Other Provider Identifier State #3
|
|
Other Provider Identifier Issuer 3
|
N/D
|
|
Other Provider Identifier Issuer #3
|
|
Other Provider Identifier 4
|
N/D
|
|
Other Provider Identifier #4
|
|
Other Provider Identifier Type 4
|
N/D
|
|
Other Provider Identifier Type #4
|
|
Other Provider Identifier State 4
|
N/D
|
|
Other Provider Identifier State #4
|
|
Other Provider Identifier Issuer 4
|
N/D
|
|
Other Provider Identifier Issuer #4
|
|
Other Provider Identifier 5
|
N/D
|
|
Other Provider Identifier #5
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Other Provider Identifier Type 5
|
N/D
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Other Provider Identifier Type #5
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Other Provider Identifier State 5
|
N/D
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Other Provider Identifier State #5
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Other Provider Identifier Issuer 5
|
N/D
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Other Provider Identifier Issuer #5
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Other Provider Identifier 6
|
N/D
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Other Provider Identifier #6
|
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Other Provider Identifier Type 6
|
N/D
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Other Provider Identifier Type #6
|
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Other Provider Identifier State 6
|
N/D
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Other Provider Identifier State #6
|
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Other Provider Identifier Issuer 6
|
N/D
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Other Provider Identifier Issuer #6
|
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Other Provider Identifier 7
|
N/D
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Other Provider Identifier #7
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Other Provider Identifier Type 7
|
N/D
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Other Provider Identifier Type #7
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Other Provider Identifier State 7
|
N/D
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Other Provider Identifier State #7
|
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Other Provider Identifier Issuer 7
|
N/D
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Other Provider Identifier Issuer #7
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Other Provider Identifier 8
|
N/D
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Other Provider Identifier #8
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Other Provider Identifier Type 8
|
N/D
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Other Provider Identifier Type #8
|
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Other Provider Identifier State 8
|
N/D
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Other Provider Identifier State #8
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Other Provider Identifier Issuer 8
|
N/D
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Other Provider Identifier Issuer #8
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Other Provider Identifier 9
|
N/D
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Other Provider Identifier #9
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Other Provider Identifier Type 9
|
N/D
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Other Provider Identifier Type #9
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Other Provider Identifier State 9
|
N/D
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Other Provider Identifier State #9
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Other Provider Identifier Issuer 9
|
N/D
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Other Provider Identifier Issuer #9
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Other Provider Identifier 10
|
N/D
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Other Provider Identifier #10
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Other Provider Identifier Type 10
|
N/D
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Other Provider Identifier Type #10
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Other Provider Identifier State 10
|
N/D
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Other Provider Identifier State #10
|
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Other Provider Identifier Issuer 10
|
N/D
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Other Provider Identifier Issuer #10
|
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Other Provider Identifier 11
|
N/D
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Other Provider Identifier #11
|
|
Other Provider Identifier Type 11
|
N/D
|
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Other Provider Identifier Type #11
|
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Other Provider Identifier State 11
|
N/D
|
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Other Provider Identifier State #11
|
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Other Provider Identifier Issuer 11
|
N/D
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Other Provider Identifier Issuer #11
|
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Other Provider Identifier 12
|
N/D
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Other Provider Identifier #12
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Other Provider Identifier Type 12
|
N/D
|
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Other Provider Identifier Type #12
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Other Provider Identifier State 12
|
N/D
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Other Provider Identifier State #12
|
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Other Provider Identifier Issuer 12
|
N/D
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Other Provider Identifier Issuer #12
|
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Other Provider Identifier 13
|
N/D
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Other Provider Identifier #13
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Other Provider Identifier Type 13
|
N/D
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Other Provider Identifier Type #13
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Other Provider Identifier State 13
|
N/D
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Other Provider Identifier State #13
|
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Other Provider Identifier Issuer 13
|
N/D
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Other Provider Identifier Issuer #13
|
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Other Provider Identifier 14
|
N/D
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Other Provider Identifier #14
|
|
Other Provider Identifier Type 14
|
N/D
|
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Other Provider Identifier Type #14
|
|
Other Provider Identifier State 14
|
N/D
|
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Other Provider Identifier State #14
|
|
Other Provider Identifier Issuer 14
|
N/D
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Other Provider Identifier Issuer #14
|
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Other Provider Identifier 15
|
N/D
|
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Other Provider Identifier #15
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|
Other Provider Identifier Type 15
|
N/D
|
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Other Provider Identifier Type #15
|
|
Other Provider Identifier State 15
|
N/D
|
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Other Provider Identifier State #15
|
|
Other Provider Identifier Issuer 15
|
N/D
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Other Provider Identifier Issuer #15
|
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Other Provider Identifier 16
|
N/D
|
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Other Provider Identifier #16
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|
Other Provider Identifier Type 16
|
N/D
|
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Other Provider Identifier Type #16
|
|
Other Provider Identifier State 16
|
N/D
|
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Other Provider Identifier State #16
|
|
Other Provider Identifier Issuer 16
|
N/D
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Other Provider Identifier Issuer #16
|
|
Other Provider Identifier 17
|
N/D
|
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Other Provider Identifier #17
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|
Other Provider Identifier Type 17
|
N/D
|
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Other Provider Identifier Type #17
|
|
Other Provider Identifier State 17
|
N/D
|
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Other Provider Identifier State #17
|
|
Other Provider Identifier Issuer 17
|
N/D
|
|
Other Provider Identifier Issuer #17
|
|
Other Provider Identifier 18
|
N/D
|
|
Other Provider Identifier #18
|
|
Other Provider Identifier Type 18
|
N/D
|
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Other Provider Identifier Type #18
|
|
Other Provider Identifier State 18
|
N/D
|
|
Other Provider Identifier State #18
|
|
Other Provider Identifier Issuer 18
|
N/D
|
|
Other Provider Identifier Issuer #18
|
|
Other Provider Identifier 19
|
N/D
|
|
Other Provider Identifier #19
|
|
Other Provider Identifier Type 19
|
N/D
|
|
Other Provider Identifier Type #19
|
|
Other Provider Identifier State 19
|
N/D
|
|
Other Provider Identifier State #19
|
|
Other Provider Identifier Issuer 19
|
N/D
|
|
Other Provider Identifier Issuer #19
|
|
Other Provider Identifier 20
|
N/D
|
|
Other Provider Identifier #20
|
|
Other Provider Identifier Type 20
|
N/D
|
|
Other Provider Identifier Type #20
|
|
Other Provider Identifier State 20
|
N/D
|
|
Other Provider Identifier State #20
|
|
Other Provider Identifier Issuer 20
|
N/D
|
|
Other Provider Identifier Issuer #20
|
|
Other Provider Identifier 21
|
N/D
|
|
Other Provider Identifier #21
|
|
Other Provider Identifier Type 21
|
N/D
|
|
Other Provider Identifier Type #21
|
|
Other Provider Identifier State 21
|
N/D
|
|
Other Provider Identifier State #21
|
|
Other Provider Identifier Issuer 21
|
N/D
|
|
Other Provider Identifier Issuer #21
|
|
Other Provider Identifier 22
|
N/D
|
|
Other Provider Identifier #22
|
|
Other Provider Identifier Type 22
|
N/D
|
|
Other Provider Identifier Type #22
|
|
Other Provider Identifier State 22
|
N/D
|
|
Other Provider Identifier State #22
|
|
Other Provider Identifier Issuer 22
|
N/D
|
|
Other Provider Identifier Issuer #22
|
|
Other Provider Identifier 23
|
N/D
|
|
Other Provider Identifier #23
|
|
Other Provider Identifier Type 23
|
N/D
|
|
Other Provider Identifier Type #23
|
|
Other Provider Identifier State 23
|
N/D
|
|
Other Provider Identifier State #23
|
|
Other Provider Identifier Issuer 23
|
N/D
|
|
Other Provider Identifier Issuer #23
|
|
Other Provider Identifier 24
|
N/D
|
|
Other Provider Identifier #24
|
|
Other Provider Identifier Type 24
|
N/D
|
|
Other Provider Identifier Type #24
|
|
Other Provider Identifier State 24
|
N/D
|
|
Other Provider Identifier State #24
|
|
Other Provider Identifier Issuer 24
|
N/D
|
|
Other Provider Identifier Issuer #24
|
|
Other Provider Identifier 25
|
N/D
|
|
Other Provider Identifier #25
|
|
Other Provider Identifier Type 25
|
N/D
|
|
Other Provider Identifier Type #25
|
|
Other Provider Identifier State 25
|
N/D
|
|
Other Provider Identifier State #25
|
|
Other Provider Identifier Issuer 25
|
N/D
|
|
Other Provider Identifier Issuer #25
|
|
Other Provider Identifier 26
|
N/D
|
|
Other Provider Identifier #26
|
|
Other Provider Identifier Type 26
|
N/D
|
|
Other Provider Identifier Type #26
|
|
Other Provider Identifier State 26
|
N/D
|
|
Other Provider Identifier State #26
|
|
Other Provider Identifier Issuer 26
|
N/D
|
|
Other Provider Identifier Issuer #26
|
|
Other Provider Identifier 27
|
N/D
|
|
Other Provider Identifier #27
|
|
Other Provider Identifier Type 27
|
N/D
|
|
Other Provider Identifier Type #27
|
|
Other Provider Identifier State 27
|
N/D
|
|
Other Provider Identifier State #27
|
|
Other Provider Identifier Issuer 27
|
N/D
|
|
Other Provider Identifier Issuer #27
|
|
Other Provider Identifier 28
|
N/D
|
|
Other Provider Identifier #28
|
|
Other Provider Identifier Type 28
|
N/D
|
|
Other Provider Identifier Type #28
|
|
Other Provider Identifier State 28
|
N/D
|
|
Other Provider Identifier State #28
|
|
Other Provider Identifier Issuer 28
|
N/D
|
|
Other Provider Identifier Issuer #28
|
|
Other Provider Identifier 29
|
N/D
|
|
Other Provider Identifier #29
|
|
Other Provider Identifier Type 29
|
N/D
|
|
Other Provider Identifier Type #29
|
|
Other Provider Identifier State 29
|
N/D
|
|
Other Provider Identifier State #29
|
|
Other Provider Identifier Issuer 29
|
N/D
|
|
Other Provider Identifier Issuer #29
|
|
Other Provider Identifier 30
|
N/D
|
|
Other Provider Identifier #30
|
|
Other Provider Identifier Type 30
|
N/D
|
|
Other Provider Identifier Type #30
|
|
Other Provider Identifier State 30
|
N/D
|
|
Other Provider Identifier State #30
|
|
Other Provider Identifier Issuer 30
|
N/D
|
|
Other Provider Identifier Issuer #30
|
|
Other Provider Identifier 31
|
N/D
|
|
Other Provider Identifier #31
|
|
Other Provider Identifier Type 31
|
N/D
|
|
Other Provider Identifier Type #31
|
|
Other Provider Identifier State 31
|
N/D
|
|
Other Provider Identifier State #31
|
|
Other Provider Identifier Issuer 31
|
N/D
|
|
Other Provider Identifier Issuer #31
|
|
Other Provider Identifier 32
|
N/D
|
|
Other Provider Identifier #32
|
|
Other Provider Identifier Type 32
|
N/D
|
|
Other Provider Identifier Type #32
|
|
Other Provider Identifier State 32
|
N/D
|
|
Other Provider Identifier State #32
|
|
Other Provider Identifier Issuer 32
|
N/D
|
|
Other Provider Identifier Issuer #32
|
|
Other Provider Identifier 33
|
N/D
|
|
Other Provider Identifier #33
|
|
Other Provider Identifier Type 33
|
N/D
|
|
Other Provider Identifier Type #33
|
|
Other Provider Identifier State 33
|
N/D
|
|
Other Provider Identifier State #33
|
|
Other Provider Identifier Issuer 33
|
N/D
|
|
Other Provider Identifier Issuer #33
|
|
Other Provider Identifier 34
|
N/D
|
|
Other Provider Identifier #34
|
|
Other Provider Identifier Type 34
|
N/D
|
|
Other Provider Identifier Type #34
|
|
Other Provider Identifier State 34
|
N/D
|
|
Other Provider Identifier State #34
|
|
Other Provider Identifier Issuer 34
|
N/D
|
|
Other Provider Identifier Issuer #34
|
|
Other Provider Identifier 35
|
N/D
|
|
Other Provider Identifier #35
|
|
Other Provider Identifier Type 35
|
N/D
|
|
Other Provider Identifier Type #35
|
|
Other Provider Identifier State 35
|
N/D
|
|
Other Provider Identifier State #35
|
|
Other Provider Identifier Issuer 35
|
N/D
|
|
Other Provider Identifier Issuer #35
|
|
Other Provider Identifier 36
|
N/D
|
|
Other Provider Identifier #36
|
|
Other Provider Identifier Type 36
|
N/D
|
|
Other Provider Identifier Type #36
|
|
Other Provider Identifier State 36
|
N/D
|
|
Other Provider Identifier State #36
|
|
Other Provider Identifier Issuer 36
|
N/D
|
|
Other Provider Identifier Issuer #36
|
|
Other Provider Identifier 37
|
N/D
|
|
Other Provider Identifier #37
|
|
Other Provider Identifier Type 37
|
N/D
|
|
Other Provider Identifier Type #37
|
|
Other Provider Identifier State 37
|
N/D
|
|
Other Provider Identifier State #37
|
|
Other Provider Identifier Issuer 37
|
N/D
|
|
Other Provider Identifier Issuer #37
|
|
Other Provider Identifier 38
|
N/D
|
|
Other Provider Identifier #38
|
|
Other Provider Identifier Type 38
|
N/D
|
|
Other Provider Identifier Type #38
|
|
Other Provider Identifier State 38
|
N/D
|
|
Other Provider Identifier State #38
|
|
Other Provider Identifier Issuer 38
|
N/D
|
|
Other Provider Identifier Issuer #38
|
|
Other Provider Identifier 39
|
N/D
|
|
Other Provider Identifier #39
|
|
Other Provider Identifier Type 39
|
N/D
|
|
Other Provider Identifier Type #39
|
|
Other Provider Identifier State 39
|
N/D
|
|
Other Provider Identifier State #39
|
|
Other Provider Identifier Issuer 39
|
N/D
|
|
Other Provider Identifier Issuer #39
|
|
Other Provider Identifier 40
|
N/D
|
|
Other Provider Identifier #40
|
|
Other Provider Identifier Type 40
|
N/D
|
|
Other Provider Identifier Type #40
|
|
Other Provider Identifier State 40
|
N/D
|
|
Other Provider Identifier State #40
|
|
Other Provider Identifier Issuer 40
|
N/D
|
|
Other Provider Identifier Issuer #40
|
|
Other Provider Identifier 41
|
N/D
|
|
Other Provider Identifier #41
|
|
Other Provider Identifier Type 41
|
N/D
|
|
Other Provider Identifier Type #41
|
|
Other Provider Identifier State 41
|
N/D
|
|
Other Provider Identifier State #41
|
|
Other Provider Identifier Issuer 41
|
N/D
|
|
Other Provider Identifier Issuer #41
|
|
Other Provider Identifier 42
|
N/D
|
|
Other Provider Identifier #42
|
|
Other Provider Identifier Type 42
|
N/D
|
|
Other Provider Identifier Type #42
|
|
Other Provider Identifier State 42
|
N/D
|
|
Other Provider Identifier State #42
|
|
Other Provider Identifier Issuer 42
|
N/D
|
|
Other Provider Identifier Issuer #42
|
|
Other Provider Identifier 43
|
N/D
|
|
Other Provider Identifier #43
|
|
Other Provider Identifier Type 43
|
N/D
|
|
Other Provider Identifier Type #43
|
|
Other Provider Identifier State 43
|
N/D
|
|
Other Provider Identifier State #43
|
|
Other Provider Identifier Issuer 43
|
N/D
|
|
Other Provider Identifier Issuer #43
|
|
Other Provider Identifier 44
|
N/D
|
|
Other Provider Identifier #44
|
|
Other Provider Identifier Type 44
|
N/D
|
|
Other Provider Identifier Type #44
|
|
Other Provider Identifier State 44
|
N/D
|
|
Other Provider Identifier State #44
|
|
Other Provider Identifier Issuer 44
|
N/D
|
|
Other Provider Identifier Issuer #44
|
|
Other Provider Identifier 45
|
N/D
|
|
Other Provider Identifier #45
|
|
Other Provider Identifier Type 45
|
N/D
|
|
Other Provider Identifier Type #45
|
|
Other Provider Identifier State 45
|
N/D
|
|
Other Provider Identifier State #45
|
|
Other Provider Identifier Issuer 45
|
N/D
|
|
Other Provider Identifier Issuer #45
|
|
Other Provider Identifier 46
|
N/D
|
|
Other Provider Identifier #46
|
|
Other Provider Identifier Type 46
|
N/D
|
|
Other Provider Identifier Type #46
|
|
Other Provider Identifier State 46
|
N/D
|
|
Other Provider Identifier State #46
|
|
Other Provider Identifier Issuer 46
|
N/D
|
|
Other Provider Identifier Issuer #46
|
|
Other Provider Identifier 47
|
N/D
|
|
Other Provider Identifier #47
|
|
Other Provider Identifier Type 47
|
N/D
|
|
Other Provider Identifier Type #47
|
|
Other Provider Identifier State 47
|
N/D
|
|
Other Provider Identifier State #47
|
|
Other Provider Identifier Issuer 47
|
N/D
|
|
Other Provider Identifier Issuer #47
|
|
Other Provider Identifier 48
|
N/D
|
|
Other Provider Identifier #48
|
|
Other Provider Identifier Type 48
|
N/D
|
|
Other Provider Identifier Type #48
|
|
Other Provider Identifier State 48
|
N/D
|
|
Other Provider Identifier State #48
|
|
Other Provider Identifier Issuer 48
|
N/D
|
|
Other Provider Identifier Issuer #48
|
|
Other Provider Identifier 49
|
N/D
|
|
Other Provider Identifier #49
|
|
Other Provider Identifier Type 49
|
N/D
|
|
Other Provider Identifier Type #49
|
|
Other Provider Identifier State 49
|
N/D
|
|
Other Provider Identifier State #49
|
|
Other Provider Identifier Issuer 49
|
N/D
|
|
Other Provider Identifier Issuer #49
|
|
Other Provider Identifier 50
|
N/D
|
|
Other Provider Identifier #50
|
|
Other Provider Identifier Type 50
|
N/D
|
|
Other Provider Identifier Type #50
|
|
Other Provider Identifier State 50
|
N/D
|
|
Other Provider Identifier State #50
|
|
Other Provider Identifier Issuer 50
|
N/D
|
|
Other Provider Identifier Issuer #50
|
|
Healthcare Provider Taxonomy Group 1
|
N/D
|
|
Healthcare Provider Taxonomy Group 1
|
|
Healthcare Provider Taxonomy Group Description 1
|
N/D
|
|
Healthcare Provider Taxonomy Group Description 1
|
|
Healthcare Provider Taxonomy Group 2
|
N/D
|
|
Healthcare Provider Taxonomy Group 2
|
|
Healthcare Provider Taxonomy Group Description 2
|
N/D
|
|
Healthcare Provider Taxonomy Group Description 2
|
|
Healthcare Provider Taxonomy Group 3
|
N/D
|
|
Healthcare Provider Taxonomy Group 3
|
|
Healthcare Provider Taxonomy Group Description 3
|
N/D
|
|
Healthcare Provider Taxonomy Group Description 3
|
|
Healthcare Provider Taxonomy Group 4
|
N/D
|
|
Healthcare Provider Taxonomy Group 4
|
|
Healthcare Provider Taxonomy Group Description 4
|
N/D
|
|
Healthcare Provider Taxonomy Group Description 4
|
|
Healthcare Provider Taxonomy Group 5
|
N/D
|
|
Healthcare Provider Taxonomy Group 5
|
|
Healthcare Provider Taxonomy Group Description 5
|
N/D
|
|
Healthcare Provider Taxonomy Group Description 5
|
|
Healthcare Provider Taxonomy Group 6
|
N/D
|
|
Healthcare Provider Taxonomy Group 6
|
|
Healthcare Provider Taxonomy Group Description 6
|
N/D
|
|
Healthcare Provider Taxonomy Group Description 6
|
|
Healthcare Provider Taxonomy Group 7
|
N/D
|
|
Healthcare Provider Taxonomy Group 7
|
|
Healthcare Provider Taxonomy Group Description 7
|
N/D
|
|
Healthcare Provider Taxonomy Group Description 7
|
|
Healthcare Provider Taxonomy Group 8
|
N/D
|
|
Healthcare Provider Taxonomy Group 8
|
|
Healthcare Provider Taxonomy Group Description 8
|
N/D
|
|
Healthcare Provider Taxonomy Group Description 8
|
|
Healthcare Provider Taxonomy Group 9
|
N/D
|
|
Healthcare Provider Taxonomy Group 9
|
|
Healthcare Provider Taxonomy Group Description 9
|
N/D
|
|
Healthcare Provider Taxonomy Group Description 9
|
|
Healthcare Provider Taxonomy Group 10
|
N/D
|
|
Healthcare Provider Taxonomy Group 10
|
|
Healthcare Provider Taxonomy Group Description 10
|
N/D
|
|
Healthcare Provider Taxonomy Group Description 10
|
|
Healthcare Provider Taxonomy Group 11
|
N/D
|
|
Healthcare Provider Taxonomy Group 11
|
|
Healthcare Provider Taxonomy Group Description 11
|
N/D
|
|
Healthcare Provider Taxonomy Group Description 11
|
|
Healthcare Provider Taxonomy Group 12
|
N/D
|
|
Healthcare Provider Taxonomy Group 12
|
|
Healthcare Provider Taxonomy Group Description 12
|
N/D
|
|
Healthcare Provider Taxonomy Group Description 12
|
|
Healthcare Provider Taxonomy Group 13
|
N/D
|
|
Healthcare Provider Taxonomy Group 13
|
|
Healthcare Provider Taxonomy Group Description 13
|
N/D
|
|
Healthcare Provider Taxonomy Group Description 13
|
|
Healthcare Provider Taxonomy Group 14
|
N/D
|
|
Healthcare Provider Taxonomy Group 14
|
|
Healthcare Provider Taxonomy Group Description 14
|
N/D
|
|
Healthcare Provider Taxonomy Group Description 14
|
|
Healthcare Provider Taxonomy Group 15
|
N/D
|
|
Healthcare Provider Taxonomy Group 15
|
|
Healthcare Provider Taxonomy Group Description 15
|
N/D
|
|
Healthcare Provider Taxonomy Group Description 15
|
|
Certification Date
|
N/D
|
|
Certification Date
|